Abstract：Objective To review the progress in reconstruction of lower extremity soft-tissue defects using perforator flaps.Methods Articles about perforator flaps using for the lower-limb wound reconstruction from January 1980 to April 2014 from databases such as PubMed, EMbase, CNKI and Cochrane Library were manually searched. The 264 articles were selected after they were inspected by the excluded and included standards. The safety, anatomical basis, advantages and disadvantages for the flaps were analysed.Results Perforator flaps, like musculocutaneous flaps, have a direct axial blood supply, and are just as effective as muscle flaps in the setting of radiation, hardware infection, or osteomyelitis. The major perforator flaps for the lower extremity reconstruction including anterolateral thigh flap, deep inferior epigastric perforator flap, thoracodorsal artery perforator flap, gluteal artery perforator flap and lower leg perforator flap. All these perforator flaps have each advantage, and can be selected according to the defect feature and the requirement of reconstruction.Conclusions Reconstruction the lower extremity soft-tissue defect using perforator flap is an effective method with low donor site morbidity. It is a new technology for lower extremity soft-tissue defect reconstruction, and the newest trend of development in flap surgery.
冯仕明,王爱国. 穿支皮瓣在下肢创面修复中的临床应用研究进展[J]. 中华解剖与临床杂志, 2015, 20(3): 272-275.
Feng Shiming, Wang Aiguo. Research progress in reconstruction of lower extremity soft-tissue defects using perforator flaps. Chinese Journal of Anatomy and Clinics, 2015, 20(3): 272-275.
Iorio ML, Cheerharan M, Olding M. A systematic review and pooled analysis of peroneal artery perforators for fibula osteocutaneous and perforator flaps[J]. Plast Reconstr Surg, 2012, 130(3): 600-607.
Huemer GM, Puelzl P, Schoeller T. Breast and chest wall reconstruction with the transverse musculocutaneous gracilis flap in Poland syndrome[J]. Plast Reconstr Surg, 2012, 130(4): 779-783.
[5]
Sameem M, Au M, Wood T, et al. A systematic review of complication and recurrence rates of musculocutaneous, fasciocutaneous, and perforator-based flaps for treatment of pressure sores[J]. Plast Reconstr Surg, 2012, 130(1): 67e-77e.
[6]
Koshima I, Soeda S. Inferior epigastric artery skin flaps without rectus abdominis muscle[J]. Br J Plast Surg, 1989, 42(6): 645-648.
[7]
Wei FC, Jain V, Suominen S, et al. Confusion among perforator flaps: what is a true perforator flap?[J] Plast Reconstr Surg, 2001, 107(3): 874-876.
[8]
Hallock GG. The medial circumflex femoral (gracilis) local perforator flap-a local medial groin perforator flap[J]. Ann Plast Surg, 2003, 51(5): 460-464.
Nagarjuna M, Patil BR, Nagraj N, et al. Use of superiorly based vertical rectus abdominis myocutaneous flap for the correction of costal osteomyelitis at the pectoralis major myocutaneous flap donor site[J]. J Oral Maxillofac Surg, 2013, 71(2): e132-e136.
[11]
Demirseren ME, Efendioglu K, Demiralp CO, et al. Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg[J]. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1613-1620.
[12]
Eric′ M, Ravnik D, Zic R, et al. Deep inferior epigastric perforator flap: an anatomical study of the perforators and local vascular differences[J]. Microsurgery, 2012, 32(1): 43-49.
[13]
Jandali S, Mirzabeigi MN, Fosnot J, et al. Thoracodorsal artery perforator flaps and muscle-sparing latissimus dorsi myocutaneous flaps for the treatment of axillary hidradenitis[J]. Ann Plast Surg, 2012, 69(4): 371-375.
[14]
Efron JE. Prospective evaluation of a single-sided innervated gluteal artery perforator flap for reconstruction of extensive and recurrent pilonidal sinus disease: functional, aesthetic, and patient-reported long-term outcomes[J]. World J Surg, 2012, 36(9): 2237-2238.
[15]
Hafeez K, Siddiqui A, Rashid HU, et al. The posterior tibial island flap for coverage in complex injuries of the lower extremity[J]. Microsurgery, 2012, 32(7): 539-545.
[16]
Yan H, Yang M, Lineaweaver WC, et al. Flap reconstruction of distal lower extremity wounds in diabetic patients[J]. Ann Plast Surg, 2011, 67(4): 426-428.
[17]
Zeltzer AA, Van Landuyt K. Reconstruction of a massive lower limb soft-tissue defect by giant free DIEAP flap[J]. J Plast Reconstr Aesthet Surg, 2012, 65(2): e42-e45.
Yang LC, Wang XC, Bentz ML, et al. Clinical application of the thoracodorsal artery perforator flaps[J]. J Plast Reconstr Aesthet Surg, 2013, 66(2): 193-200.
[20]
Georgescu AV. Propeller perforator flaps in distal lower leg: evolution and clinical applications[J]. Arch Plast Surg, 2012, 39(2): 94-105.
[21]
Liu L, Liu Y, Zou L, et al. The distally based superficial sural flap for reconstruction of the foot and ankle in pediatric patients[J]. J Reconstr Microsurg, 2013, 29(3): 199-204.
Hedegard W, Niell B, Specht M, et al. Breast reconstruction with a deep inferior epigastric perforator flap: imaging appearances of the normal flap and common complications[J]. AJR Am J Roentgenol, 2013, 200(1): w75-84.
[24]
Bach CA, Wagner I, Lachiver X, et al. The free thoracodorsal artery perforator flap in head and neck reconstruction[J]. Eur Ann Otorhinolaryngol Head Neck Dis, 2012, 129(3): 167-171.
[25]
Lakhiani C, Lee MR, Saint-Cyr M. Vascular anatomy of the anterolateral thigh flap: a systematic review[J]. Plast Reconstr Surg, 2012, 130(6): 1254-1268.
Krochmal DJ, Rebecca AM, Casey WJ 3rd, et al. Anterolateral thigh flap salvage following failed deep inferior epigastric artery perforator breast reconstruction[J]. Can J Plast Surg, 2011, 19(1): 27-30.
[28]
Bianchi B, Ferri A, Ferrari S, et al. The free anterolateral thigh musculocutaneous flap for head and neck reconstruction: one surgeon′s experience in 92 cases[J]. Microsurgery, 2012, 32(2): 87-95.
[29]
Lee MJ, Yun IS, Rah DK, et al. Lower extremity reconstruction using vastus lateralis myocutaneous flap versus anterolateral thigh fasciocutaneous flap[J]. Arch Plast Surg, 2012, 39(4): 367-375.
[30]
Wong CH, Goh T, Tan BK, et al. The anterolateral thigh perforator flap for reconstruction of knee defects[J]. Ann Plast Surg, 2013, 70(3): 337-342.
[31]
Kim H, Lim SY, Pyon JK, et al. Rib-Sparing and internal mammary artery-preserving microsurgical breast reconstruction with the free DIEP flap[J]. Plast Reconstr Surg, 2013, 131(3): 327e-334e.
[32]
Masià J, Sommario M, Cervelli D, et al. Extended deep inferior epigastric artery perforator flap for head and neck reconstruction: a clinical experience with 100 patients[J]. Head Neck, 2011, 33(9): 1328-1334.
[33]
Chen HC, Tang YB, Mardini S, et al. Reconstruction of the hand and upper limb with free flaps based on musculocutaneous perforators[J]. Microsurgery, 2004, 24(4): 270-280.
[34]
Grinsell D, Saravolac V, Rozen WM, et al. Pre-expanded bipedicled deep inferior epigastric artery perforator (DIEP) flap for paediatric lower limb reconstruction[J]. J Plast Reconstr Aesthet Surg, 2012, 65(11): 1603-1605.
[35]
Van Landuyt K, Blondeel P, Hamdi M, et al. The versatile DIEP flap: its use in lower extremity reconstruction[J]. Br J Plast Surg, 2005, 58(1): 2-13.
[36]
Holm C, Mayr M, Hfter E, et al. Interindividual variability of the SIEA Angiosome: effects on operative strategies in breast reconstruction[J]. Plast Reconstr Surg, 2008, 122(6): 1612-1620.
[37]
Schaverien M, Wong C, Bailey S, et al. Thoracodorsal artery perforator flap and latissimus dorsi myocutaneous flap-anatomical study of the constant skin paddle perforator locations[J]. J Plast Reconstr Aesthet Surg, 2010, 63(12): 2 123-2 127.
[38]
Jeon BJ, Lee KT, Lim SY, et al. Plantar reconstruction with free thoracodorsal artery perforator flaps[J]. J Plast Reconstr Aesthet Surg, 2013, 66(3): 406-413.
[39]
Tuinder S, Van Der Hulst R. Introducing the septocutaneous gluteal artery perforator flap: a simplified approach to microsurgical breast reconstruction[J]. Plast Reconstr Surg, 2012, 129(5): 848e-849e.
[40]
Quilichini J, Hivelin M, Matar N, et al. Septocutaneous gluteal artery perforator flap in lateral decubitus position for breast reconstruction[J]. Plast Reconstr Surg, 2012, 129(2): 385e-386e.
Schaverien M, Saint-Cyr M. Perforators of the lower leg: analysis of perforator locations and clinical application for pedicled perforator flaps[J]. Plast Reconstr Surg, 2008, 122(1): 161-170.
[43]
Adhikari S, Bandyopadhyay T, Saha JK. Anterior tibial artery perforator plus flaps for reconstruction of post-burn flexion contractures of the knee joint[J]. Ann Burns Fire Disasters, 2012, 25(2): 86-91.
2015, Vol. 20 
